MULTI-METHOD ASSESSMENT OF MEDICAID MANAGED CARE

1997年，新墨西哥州启动了一项医疗补助计划 管理型医疗(MMC)。研究这项改革的效果是很重要的 在新墨西哥州，由于先前关于管理性医疗的研究提出了 关于它的适用性和潜在的 在以农村、贫困和种族为主的地区成功实施 不同的州。 我们的项目解决了三个具体目标，这三个目标源于 追踪医疗改革影响的概念模型 个人、组织/社区和人口级别的分析： 1)评估个人=可获得性、满意度、目标医疗保健 结果，以及实施MMC前后的护理费用。我们 将通过重点关注地理位置的调查方法来解决这一目标 低收入居民比例较高的地区。此组件 将使我们能够研究这些关键指标的变化 医疗补助患者的水平，有资格享受医疗补助但不能 登记的，那些被其他公共和私人保险计划覆盖的人， 以及那些没有保险的人。2)考察MMC改革对安全的影响- 为高危群体和社区提供服务的网络机构。 民族志研究方法将通过关注以下方面来解决这一目标 收入支持办公室、社区卫生中心、急诊科、 私人执业医生办公室和管理式护理组织 城乡统筹。3)衡量可预防的、不利的 哨兵的健康结果。我们将通过这项研究实现这一目标 提供有关可预防措施的信息的管理数据库 在人口层面上的成果。 该项目涉及一个跨学科的研究团队，横跨 新墨西哥大学的几个学术单位，以及 新墨西哥州卫生部的调查人员。 本项目将提供有关MMC影响的实用知识 这可以指导新墨西哥州和其他州未来的政策决策 与农村和种族多样化的人口。多方法方法 将调查工作、人种学观察和对 管理数据库将在允许 “三角测量”的互补方法，以得出关于 MMC的多方面影响。这一方法论的进步将证明 有助于全国和其他州对未来的评估 医疗政策的变化。

During 1997, the State of New Mexico initiated a program of Medicaid managed care (MMC). It is important to study the effects of this reform in New Mexico, since prior research on managed care has raised substantial questions about its applicability and potential for successful implementation in predominantly rural, poor, and ethnically diverse states. Our project addresses three specific aims, which derive from a conceptual model that traces the effects of health care reform at the individual, organizational/community, and population levels of analysis: 1) To assess individuals'=access, satisfaction, targeted healthcare outcomes, and costs of care before and after implementation of MMC. We will address this aim through survey methods focusing on geographical areas with a high proportion of low-income residents. This component will allow us to study changes in these key indicators at the individual level among Medicaid patients, persons eligible for Medicaid but not enrolled, those covered by other public and private insurance programs, and the uninsured. 2) To examine the effects of MMC reform on safety- net institutions serving at-risk groups and on communities. Ethnographic research methods will address this aim by focusing on income support offices, community health centers, emergency departments, private practitioners' offices, and managed care organizations in both urban and rural areas. 3) To measure changes in preventable, adverse sentinel health outcomes. We will accomplish this aim through the study of administrative databases which provide information about preventable outcomes at the level of the population. The project involves an interdisciplinary team of researchers, spanning several academic units at the University of New Mexico, as well as investigators with the New Mexico Department of Health. This project will provide practical knowledge about the impact of MMC that can guide future policy decisions in New Mexico and other states with rural and ethnically diverse populations. The multimethod approach of combining survey work, ethnographic observations, and study of administrative databases will break new ground in permitting a "triangulation" of complementary methods to reach conclusions about the multifaceted impacts of MMC. This methodologic advance will prove helpful nationally and in other states for the evaluation of future health policy changes.